Postoperative emergence delirium (ED) in adults is MOST reliably distinguished from residual anaesthesia effects by which feature?

• A Hyperventilation and tachycardia which responds to benzodiazepines
• B Bradycardia and miosis indicating opioid excess as the primary aetiology
• C Presence of metabolic alkalosis on ABG
• D Occurrence within the first 30 minutes of recovery with agitation, disorientation, and inconsolability despite adequate analgesia ✓

Explanation

Emergence delirium (ED) in adults is characterised by agitation, disorientation, combativeness, and inconsolability occurring in the early recovery phase (typically within 30 minutes of emergence), persisting after optimising analgesia, reversing neuromuscular blockade, and normalising physiology. Key triggers include pain (most common — treat first), full bladder, residual paralysis, hypoxia, and hypoglycaemia. Unlike simple sedation or pain, ED does not resolve with analgesics alone. Physostigmine (cholinesterase inhibitor) reverses anticholinergic-type ED. Dexmedetomidine or propofol may be used for refractory cases. Haloperidol/droperidol can also be used.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.